LSU Health Sciences Center New OrleansDepartment of Radiology:

Effects of Hurricane Katrina1

Anshu Duggal, BA, Janis G. Letourneau, MD, Leonard R. Bok, MD, MBA, JD

This case study chronicles the impact of Hurricane Katrina on the Department of Radiology at the Louisiana State University

School of Medicine in New Orleans and the department’s subsequent efforts to recover and re-dedicate itself to providing quality

patient care and resident education. Hurricane Katrina damaged the department’s facilities, severely decreased departmental cash

flow, disrupted resident education, and resulted in faculty exodus. Because of the ‘‘catastrophic loss of resources’’ suffered by the

department, the Accreditation Council for Graduate Medical Education (ACGME) proposed expedited withdrawal of accredi-

tation for the Diagnostic Radiology Residency Program, to which the department agreed. Since Katrina, the program has taken

steps toward regaining its pre-Katrina status as a successful residency program that produced satisfied, successful residents.

These steps include the appointment of a new department head of radiology, the recruitment of academic directors for each of the

nine subspecialties, the reopening of the University Hospital, and the growth of annual procedure volume. All institutions face the

possibility of a natural disaster. It is imperative to have a plan in place to ensure continued resident education, patient safety, and

ACGME accreditation.

Key Words. Hurricane Katrina; ACGME; accreditation; residency; LSU radiology.

ª AUR, 2009

Hurricane Katrina, one of the most deadly and most expen-

sive hurricanes ever to hit the United States, made landfall

slightly east of New Orleans early on Monday, August 29,

2005. The storm and its surge breached more than 50 canal

levees, causing 80% of the city of New Orleans to become

flooded by Wednesday, some areas with up to 15 feet of

water. More than 90% of the city’s residents were forced to

evacuate. The impact of Hurricane Katrina was far reaching

and extended beyond the parish boundaries. It is estimated

that complete recovery will cost billions of dollars and take

many more years. This case study documents the impact of

Katrina on the Department of Radiology at the Louisiana

State University (LSU) School of Medicine in New Orleans.

Acad Radiol 2009; 16:584–592

1 From the Chicago Medical School, Rosalind Franklin University of Medicine

and Science, Chicago, IL (A.D.); and the Department of Radiology, Louisiana

State University Health Sciences Center, 2020 Gravier Street, Room 755, New

Orleans, LA 70112 (J.G.L., L.R.B.). Received September 12, 2008; accepted

January 21, 2009. Address correspondence to: L.R.B. e-mail: lbok@lsuhsc.

edu

ª AUR, 2009doi:10.1016/j.acra.2009.01.016

584

Before Katrina, LSU radiology had a large, successful

residency program with dedicated faculty members, mod-

ernized facilities, and strong finances. The radiology program

had a complement of approximately 30 residents, along with

clinical fellows in programs approved by the Diagnostic

Radiology Residency Review Committee (RRC) in neuro-

radiology, vascular and interventional radiology, and mus-

culoskeletal radiology. LSU radiology’s primary practice site

was at the Medical Center of Louisiana in New Orleans

(MCLNO), one of several hospitals within the LSU public

hospital network (LSU Health Care Services Division

[HCSD]). MCLNO was composed of two campuses, Charity

Hospital and University Hospital, located within 1 mile of

each other. The department also provided services at Kenner

Regional Medical Center and some imaging services at the

New Orleans Veterans Affairs Medical Center. Residents

rotated through these other hospitals, as well as New Orleans

Children’s Hospital. Faculty members included approxi-

mately 28 full-time clinical radiologists (not including one

faculty member appointed to the dean’s staff who remained

clinically active), along with two full-time research faculty

members and one full-time and one part-time physicist. The

Academic Radiology, Vol 16, No 5, May 2009 LSU RADIOLOGY: EFFECTS OF HURRICANE KATRINA

LSU Diagnostic Radiology Residency Program was granted

a 5-year review cycle on the basis of an Accreditation

Council for Graduate Medical Education (ACGME) site visit

on April 4, 2003, and routinely produced satisfied, successful

residents who pursued both academic and community

practice opportunities.

KATRINA’S IMPACT ON LSU RADIOLOGY

In the days leading up to Hurricane Katrina, some senior

residents volunteered to take a code gray call, believing that

this hurricane would be no different from those that had

recently preceded it. Volunteering for a code gray call was

considered a privilege, because residents who served a 24- to

48-hour code gray call were those considered the most ver-

satile and capable (and they were also entitled to time off in

the coming days to sort out whatever aftereffects of the storm

might be left behind). Tropical storms and hurricanes are

a common occurrence along the entire Gulf Coast; most cit-

izens of this area had experienced such weather occurrences

in the past, and although evacuation was commonplace for

lay citizens, hospital evacuations were not planned for or

undertaken. In recent hurricane scares, routine hospital op-

erations had been suspended for 24 to 48 hours during vol-

untary evacuations of the city proper. However, in the days

leading up to landfall, there was widespread concern that

Katrina was bigger and potentially more devastating than its

recent predecessors; satellite imagery revealed that Katrina

filled the entire Gulf of Mexico. As such, neither the hospital

nor the department had a formal evacuation plan in place.

Essentially all the radiology residents and faculty members

not in house for the code gray call appropriately moved to

safer locations across the state and region.

Preparations for the storm also took place on the academic

side of the campus operation. Anticipating a several-day

interruption in operations, at a minimum, the LSU Health

Sciences Center (LSUHSC) human resources department

made arrangements to run payroll early, and contingency

plans were made to relocate essential services at the main

LSU campus in Baton Rouge or other state facilities in either

Baton Rouge or Shreveport. Faculty and staff members are

granted special leave for hurricane disruptions if they are not

assigned to work as essential personnel either in a clinical

setting or otherwise; Katrina went on to prove its exceptional

character, as many of the faculty and staff members remained

on special leave formally until November 30, 2005, even if

they resumed some academic or clinical activities.

FACILITIES

Both MCLNO campuses experienced severe flooding,

and as a consequence, both University Hospital and Charity

Hospital sustained severe disruptions in critical utilities, in-

cluding the loss of running water, and the facilities relied on

generator power for emergency electrical needs. Immediately

after the storm, streets had indeed taken on water, but only up

to a level expected after such a storm. However, within about

10 to 12 hours after several levees were breached, the water

level rose, flooding the entire basements of both hospitals.

The plan was to keep patients two floors above any area that

suffered flooding. As such, the first floors of both hospitals

were evacuated, with patients being moved to the second

floor. There were no injuries to any patients or staff members

during the flooding.

With help from the Louisiana National Guard and local

support services, including the Louisiana Department of

Wildlife and Fisheries, some food, water, and generator fuel

were available to provide care for those in the hospital until

September 1, when both hospitals were fully evacuated with

aid from the federal military troops and local law enforce-

ment agencies. Before the evacuation of the two campuses,

boat and amphibious convoys to the hospitals were often

intercepted by snipers and looters.

Supplies, particularly of water, ran critically low in the

days after the flooding, with faculty and staff members

rationing their own water to maintain a minimal supply for

patients. During this time, without power or water, the radi-

ology residents and faculty members, along with the

MCLNO radiology managers and technologists, worked

shoulder to shoulder with other providers in the hospital to

give as much medical aid and comfort as was possible for the

patients; senior faculty members helped transport patients on

makeshift gurneys through the stairwells to slightly cooler

locations in the buildings, while residents and faculty mem-

bers fanned and sponged patients to keep them cool in the

oppressively hot environment. Numerous acts of compassion

and heroism were reported after the rescue and evacuation as

everyone worked to overcome the total disruption of normal

hospital operations, with no computers, no telephones, no

elevators, no plumbing, and so on.

The hospital evacuations were accomplished both by boat

and by air for patients, hospital personnel, and any family

members present in the facilities. It is estimated that 170

patients and 400 employees, including nurses and physicians,

were evacuated from University Hospital, while at Charity

Hospital, 200 patients and 600 employees were evacuated

(MCLNO administration, internal document, 2007).

In October, an emergency services unit was set up in Air

Force tents on the parking lot of University Hospital and was

known as the Emergency Services Unit at the New Orleans

Center. This unit was moved to the Ernest N. Morial Con-

vention Center (in downtown New Orleans) in November

and then moved again in March 2006, still in tents, to

a Poydras Street location (also downtown) that formerly

served as a Lord & Taylor department store. In April 2006,

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[Q1]DUGGAL ET AL Academic Radiology, Vol 16, No 5, May 2009

Figure 1. Timeline for the resumption of clinical services at the Medical Center of Louisiana in New Orleans (MCLNO). MCLNO was

composed of two campuses, Charity Hospital and University Hospital.

the MCLNO Trauma Center was reopened at a suburban site

in Jefferson Parish, a part of the Ochsner Elmwood Campus,

leased from Ochsner Health System (MCLNO administra-

tion, internal document, 2007). Figure 1 shows the resump-

tion of clinical services at MCLNO.

The Department of Radiology, as an equipment-intensive

and technology-dependent discipline, suffered profound

programmatic disruption resulting from the loss of the ma-

jority of its imaging equipment (computed tomographic and

magnetic resonance imaging scanners, ultrasound machines,

nuclear medicine cameras) and Picture Archiving and

Communication System (PACS) workstations and networks.

Table 1 shows the equipment levels before Katrina at both

MCLNO campuses, as well as equipment available after the

storm, as of March 2006, at the Emergency Services Unit and

at the Elmwood facility. Also shown is equipment available

at Kenner Regional Medical Center, a private hospital with

approximately 200 beds, located in the suburban New Or-

leans area. Immediately after the storm, because the Veterans

Affairs hospital also closed because of flooding, Kenner

Regional was the only continuously operating hospital with

which the program had a pre-existing contract for services

and arrangements for training.

In addition to the loss of imaging instrumentation, staff

levels at MCLNO were hard hit following Katrina; Table 2

shows staff numbers for each modality or section both before

and after Katrina, as of March 2006. The LSU HCSD, the

public hospital entity that included MCLNO, was forced to

furlough many of its technical and nursing staff members

after the flood, with the loss of patient activity and attendant

loss of revenues.

COMMUNICATION

Immediately after Katrina, communication among

Department of Radiology faculty and staff members became

a significant problem because LSUHSC servers were down

and neither land-line nor most cellular telephones worked;

most cellular phone towers in the 504 and 985 area codes

were incapacitated with the loss of power. The program did

not have an emergency contact list widely accessible except

through the LSUHSC server. During the initial days after the

586

storm, communication occurred via a combination of private

e-mail, mainly through public-access provider e-mail

accounts, and text messaging on cell phones, which worked

more reliably because of the smaller bandwidth required to

text. In addition, the program director established an LSU

group posting area on the public Web site NOLA.com,

greatly improving administration, faculty member, and

resident interaction. Communication improved in early

September after LSUHSC’s e-mail and limited domain

servers were recovered from campus and moved to Baton

Rouge and Shreveport.

The first meeting between residents, faculty members, and

departmental administrators was held in Lafayette, more than

2 hours west of New Orleans and the medical school campus.

This meeting was conducted under the guidance of the

department head during the third week of September. At this

meeting, it was announced that the school would provide

temporary housing in the form of a floating ‘‘residential’’

ferryboat and trailers to those who needed it, including resi-

dents and faculty members; access to the New Orleans area

was still largely restricted at this time, and many residents and

faculty members were unable to determine the status of their

own homes except through satellite images available through

various governmental Web sites. Future departmental meet-

ings occurred every 3 weeks at Pennington Biomedical Re-

search Center (PBRC) in Baton Rouge, located an hour west

and slightly north of New Orleans. Baton Rouge was chosen

as the meeting site because of its relative proximity to New

Orleans and its vast array of LSU and other state resources as

the state capitol, and because central School of Medicine

operations and some LSUHSC operations had been estab-

lished at PBRC. The purpose of these meetings was to dis-

cuss various issues involving the future of the program, such

as funding, facilities and equipment including information

technology resources, patient access, faculty and staff hous-

ing, and whether residents would be allowed to transfer to

other programs if the program was not sustainable.

REGROUPING

In an attempt to hold the department together until an

assessment could be done on the feasibility of it, or at least

Academic Radiology, Vol 16, No 5, May 2009 LSU RADIOLOGY: EFFECTS OF HURRICANE KATRINA

Table 1Radiology Equipment Levels by Modality and Service Before and After Hurricane Katrina (March 2006)

Modality/Service Before Katrina* After Katrina* Kenner Regional Medical Center

CT 4 (1 Philips [64 slice], 2 GE [8 slice],

1 Siemens [4 slice])

2 (1 Siemens [6 slice],y 1 Philips

[16 slice]y)

1

MR 3 (1 Siemens [1.5 T], 1 Hitachi [0.3 T],

1 GE [1.5 T])

0 1

Ultrasound 10 (3 ATL 5000, 2 Sequoia, 1 Philips-

Mammo, 1 Philips HD [3D],

1 Acuson [XP-128] angiograph,

2 Acuson [XP-128])

4 (2 ATL 5000, 2 Sequoia) 2

Nuclear medicine 7 (2 triple head, 3 dual head, 2 single

head)

0 2 gamma cameras

PACS 114 MV (22 MV 1000, 92 MV 300),

8 plate readers

16 MV (5 MV 1000, 11 MV 300),

4 plate readers

1 UniPACS

Radiology 10 radiology rooms, 5 digital

fluoroscopy, 2 digital

mammography, 1 analog

mammography, 1 stereotactic unit,

2 angiography, 8 mobile C-arms,

11 mobile units, 1 DEXA bone

density

6 mobile units, 2 mobile C-arms,

1 general radiology room

5 radiology rooms, 1 fluoroscopy,

1 angiography, 2 mobile units,

1 DEXA bone scan

CT, computed tomography; DEXA, dual-energy x-ray absorptiometry; MR, magnetic resonance; MV, MagicView PACS workstation;PACS, Picture Archiving and Communication System.

* Pre-Katrina equipment numbers include both Charity Hospital and University Hospital. Post-Katrina equipment numbers include both the

Emergency Services Unit at the New Orleans Center and Elmwood sites.y Computed tomographic unit is mobile.

a good part of it, returning to New Orleans, residents, fellows,

and faculty members were informed by the department head

that they would be assigned to various public hospitals across

Louisiana, including Kenner Regional Medical Center.

Kenner Regional served as a ‘‘home base’’ for several resi-

dents and faculty members. The program also negotiated

a services contract with University Medical Center (also part

of HCSD) in Lafayette, which served as a ‘‘home base’’ for

other cadre of residents and faculty members; however, this

contract was terminated in the spring of 2006 by the acting

department head because of the strain on faculty resources

and a desire of some faculty members to finally return to New

Orleans. The other locations where individuals were relo-

cated for training and clinical work, for variable amounts of

time, included LSU Shreveport, Earl K. Long Medical Center

(Baton Rouge), Leonard J. Chabert Medical Center (Houma),

Lallie Kemp Medical Center (Independence), and Bogalusa

Medical Center, all hospitals within the HCSD excepting

LSU Shreveport (LSU radiology, internal document, 2006).

The hope was that displaced patients from MCLNO would

use services at other LSU HCSD hospitals and that LSU New

Orleans faculty members and residents could be deployed

temporarily to those sites until a more definite plan could be

devised. When MCLNO opened services in the Morial

Convention Center and later moved to the Lord & Taylor

building, residents and faculty members were incrementally

relocated to these sites.

However, the disruption of the entire metropolitan medi-

cal system was probably unprecedented in the United States.

Doctors and patients from throughout the New Orleans area

were scattered across the state, and LSUHSC and MCLNO

physicians and patients were no different; continuity of care

was a huge problem for everyone involved. Medical records

were not available, images and old films were not available,

and in some instances, biopsies and other critical specimens

were lost. There was interruption of dialysis, chemotherapy,

rehabilitation, and other medical programs. All of these is-

sues played into the operational concerns of the Department

of Radiology as it tried to regroup and provide services for its

displaced MCLNO patients in particular.

Limited access to patient management and patient

accounting records was restored by LSUHSC Information

Technology Services for MCLNO patients within approxi-

mately 48 hours; the MCLNO hospital information system

was housed remotely at a hardened facility operated by Sie-

mens Medical Systems in Malvern, Pennsylvania. However,

because at the time, there was no master patient index for

HCSD facilities, MCLNO patients had to be entered anew

into the hospital information system; significant, but not

inclusive, medical information was then first available via

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DUGGAL ET AL Academic Radiology, Vol 16, No 5, May 2009

CLIQ (an internally developed clinical inquiry system on

a Web-based portal) as read only and then as functional with

interface capability in November 2005. At the time of Hur-

ricane Katrina, MCLNO was the only HCSD facility using an

electronic radiology information system (RIS) and PACS,

and the servers for the RIS and PACS resided in New

Orleans. The MCLNO RIS and PACS remained down for

many months, and in the interim, it was necessary to use

a system that would allow residents and faculty members to

analyze images at temporary MCLNO facilities in New Or-

leans and also from other locations in the state. This role was

filled by using UniPACS, a pre-existing PACS developed in

house by LSUHSC and LSU (Baton Rouge) faculty and staff

members. This system enabled LSU radiologists to view

medical images from any PC with an Internet connection. In

this way, for example, a magnetic resonance imaging exam

performed at Kenner Regional could be read at University

Medical Center in Lafayette and vice versa. In addition, eFax

and Skype, software used to make calls over the Internet,

Table 2Medical Center of Louisiana in New Orleans Radiology StaffingLevels by Modality and Section Before and After HurricaneKatrina (March 2006)

Modality/SectionPre-Katrina

Staff*Post-Katrina

Staff*

Radiologic technologists 57 16

CT technologists 23 10

MR technologistsy 8 2

Angiography/interventional

technologists

5 2

Medical sonographers 11 5

Clerical support staff membersz 44 2

Physicists 2 1

Radiology registered nurses 19 0

Mammography technologists 5 0

Nuclear medicine technologists 8 0

Nuclear medicine pool

technologists

2 0

Radiology technologist poolx 4 0

CT, computed tomography; MR, magnetic resonance.

* Pre-Katrina and post-Katrina staff numbers include both Charity

Hospital and University Hospital.y There were two MR technologists despite not having any MR

services available (see Table 1) at this time because of an

unexpected delay in the delivery of our first MR mobile unit, which

was not delivered until the interim trauma unit was opened atElmwood. In the interim, these technologists’ services were used

elsewhere.z The clerical staff was substantially reduced in favor of more

technical staff members who could multitask and provide someclerical support.x The radiology technologist pool is composed of employees who

do not work full-time. They do not accrue benefits such as retirementand sick leave but are paid at a higher rate.

588

were both used to further teleradiology communications.

Skype software was also used in didactic teaching because it

allowed for interactive teleconferencing among residents and

faculty members.

RESIDENTS

After the storm struck, residents experienced a near total

disruption in their education lasting approximately 1 month;

they restarted their training on October 3, 2005, with the

reassignments that had been made by the department head

and program director. This resumption of activities paralleled

that of the School of Medicine, which miraculously restarted

preclinical classes at PBRC 4 weeks to the day from Katrina’s

landfall. The lack of facilities and patients in New Orleans

and the resulting dispersion of radiology residents to other

sites required that some residents be assigned to hospitals not

previously used by the department for training. The impact

on training was significant. For example, one of these new

educational sites was the Chabert facility in Houma, and at

least one of the residents assigned there was concerned about

the quality of his clinical experience as measured against that

at MCLNO before the storm; activities at Chabert were

limited mainly to listening to lectures and conducting case

reviews.

Over the next 2 to 3 months, it became clear that the

physical losses to the program were catastrophic. The most

devastating losses suffered by the program were due to the

flooding of both MCLNO campuses, the principal training

sites for the residents and fellows. However, all of the other

School of Medicine buildings also took on water and as

a consequence, the Radiology Learning Center was flooded,

resulting in the loss of extensive collections of radiology

journals, books, teaching files, and electronic teaching media

(LSU radiology, internal document, 2006).

Although some research projects had to be discontinued

because of the loss of faculty members and resources, several

others continued, and a number of publications and presen-

tations were carried to fruition. Senior residents preparing to

take their board exams continued to receive their training and

board review sessions. Resources from Tulane University’s

Department of Radiology were also made available to them

(LSU radiology, internal document, 2006).

Many of the residents sustained immense personal hard-

ship with the storm and secondary flooding, with many losing

their homes and all of their belongings, including materials

they even needed to provide verification of their medical

graduation and licensure. Because of the suddenness of the

storm’s arrival, some residents left the city precipitously,

without critical documents or computers, taking only their

family members, minimal identification, and perhaps

a change of clothes. Facing personal and professional

Academic Radiology, Vol 16, No 5, May 2009 LSU RADIOLOGY: EFFECTS OF HURRICANE KATRINA

challenges, a number of residents decided to transfer out of

the program soon after Hurricane Katrina by making their

own arrangements. However, because of a carefully crafted

and widely distributed ‘‘understanding’’ promulgated by the

American Association of Medical Colleges (and its other

representative constituent groups) most other programs and

schools took a hands-off approach to the recruitment

(‘‘poaching’’) of students, residents, and faculty members

from the School of Medicine; this resulted in a temporary

stabilization of the program size, albeit reduced, and actually

had an inhibitory effect on voluntary resident transfer

through fall 2005 and spring 2006. A focused site visit was

scheduled, thought to be in response to an anonymous con-

cern raised by a resident to the Diagnostic Radiology RRC.

FACULTY MEMBERS

Faculty members were reassured that their salaries and

jobs would be secure. However, as the degree of devastation

in New Orleans became clearer, by November 2005, it was

apparent that cuts would need to be instituted, given the lack

of resources, financial, and otherwise. Clinical revenues, the

principal source of departmental support, had essentially

ceased. Even at large institutions, such as LSUHSC, Tulane,

and agencies of New Orleans city government, staffing could

not be sustained, because of decreased cash flow.

As one can imagine, the hardships caused by the storm

were overwhelming. A counseling service was set up for all

LSU faculty members, and LSUHSC sent out various e-mails

advertising that counseling was being offered to anyone that

needed it. At various meetings, the department head at the

time also informed all radiology faculty of the availability of

this service and encouraged those interested to take advan-

tage of it.

The Department of Radiology, like other departments at

the LSU School of Medicine as well as departments at other

institutions, including the Tulane University School of

Medicine, implemented faculty and staff reductions in

December 2005; in the case of LSU, this was done through

a furlough process established through force majeure for

LSUHSC (1). As a result of faculty reductions, at the time of

the ACGME site visit in March 2006, there were only 10

remaining faculty members. When it became clear that the

LSU Diagnostic Radiology Residency Program would be

closed, there was a further exodus of faculty members

(through retirements and resignations), so that by July 2007,

a year after the residency had closed, full-time faculty

representation had reached a nadir of seven.

In spring 2006, the residency program moved back to New

Orleans in anticipation of the focused site visit at Kenner

Regional Medical Center, because University Hospital had

not yet reopened. However, there was also turmoil in de-

partmental leadership, and a number of individuals holding

key leadership positions in the department stepped down and/

or left the department. The department head stepped down in

November 2005, after serving more than 12 years in that

capacity, and subsequently retired in February 2006. Shortly

after the March 2006 ACGME site visit, the department lost

its residency program director and co-program director, who

accepted positions elsewhere. In April 2006, the interim de-

partment head resigned (LSU radiology, internal document,

2006), and one of the associate deans, a colorectal surgeon,

was named acting department head. Recruitment efforts be-

gan shortly thereafter for a new department head, especially

challenging in face of all the uncertainties for the department

and school.

CLOSING THE RESIDENCY

In March 2006. the ACGME undertook a focused site visit

at the Kenner Regional Medical Center, which was the pri-

mary practice site for the department at that time. On the basis

of the site visitor’s report, the Diagnostic Radiology RRC

proposed the expedited withdrawal of accreditation for the

Diagnostic Radiology Residency Program at LSU because of

a ‘‘catastrophic loss of resources, including faculty, facilities,

or funding; or egregious noncompliance with accreditation

requirements’’ (ACGME letter, 2006).

The acting department head and the acting program di-

rector agreed to this proposal and closed the radiology resi-

dency and related fellowship training programs effective

June 30, 2006 (LSU radiology, internal document, 2006).

The program, drawing largely on its relationships with other

academic radiologists sympathetic to the plight of the pro-

gram, successfully helped outplace all of its residents at

ACGME-accredited radiology residency programs, largely

into vacant funded positions scattered across the country (see

Table 3 for a list of programs receiving LSU radiology resi-

dents). Placing residents from various LSU New Orleans

programs into vacant positions proved to be a temptation for

some, with some programs requesting permanent transfers of

the funding ‘‘caps’’ as a requirement for accepting the resi-

dents. (The Balanced Budget Act of 1997 placed a cap on the

number of residents Medicare would support through its di-

rect graduate medical education payment.) This raiding of

MCLNO and HCSD caps was condemned by the ACGME,

which also threatened sanctions to programs that engaged in

this type of negotiation. (We would be remiss at this point not

to clarify that Medicare funding caps reside with teaching

hospitals, not with residency programs or with residents; in

our case, the caps were controlled by MCLNO and HCSD,

and every effort was made to retain as many funded resident

positions as possible for future recovery. As a consequence,

schoolwide, the few transfers of funded positions for

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DUGGAL ET AL Academic Radiology, Vol 16, No 5, May 2009

residents were done through temporary affiliation agree-

ments, allowing the funded positions to return to MCLNO

after the residents completed training.)

THE RECOVERY

The university has implemented changes to provide

stability to the program. Subsequent to the March 2006

ACGME site visit and the resignation of the interim depart-

ment head, the university began actively recruiting a new

department head of radiology. The new department head

began his duties of stabilizing the department and building

a new radiology residency program in October 2006, 3

months after the program closed its radiology residency and

related fellowship training programs. The new department

head and his colleagues began working closely with the

ACGME and the Association of Program Directors in Radi-

ology to understand the common requirements and the spe-

cialty-specific requirements. They developed goals and

objectives for the program to address all six competencies,

including patient care, medical knowledge, practice-based

learning and improvement, interpersonal and communication

skills, professionalism, and systems-based practice, and

prepared their program information form.

The department’s main practice site, University Hospital,

was expanded, renovated, and renamed LSU Interim Hos-

Table 3Accreditation Council for Graduate Medical Education–Accredited Radiology Residency Programs to Which LouisianaState University Radiology Residents Were Outplaced

Ochsner Foundation Hospital

University of Alabama

University of South Alabama

Duke Medical Center

Fletcher Allen Hospital/University of Vermont

University of South Florida

University of Missouri–Columbia

Jacobi Medical Center

Boston University

Penn State Hershey Medical Center

University Hospital of Cleveland/Case Western

Tulane University Health Sciences Center

University of Tennessee–Knoxville

University of Alabama at Birmingham*

University of Texas Medical Branch–Galveston

Baylor University Medical Center

University of Virginia

Kaiser Permanente

Brigham and Women’s Hospital

Rush University Medical Center

* Ear, nose, and throat residency program; student had started an

ear, nose, and throat residency prior to joining Louisiana State

University radiology.

590

pital (previously MCLNO). It was reopened in November

2006. Academic directors for each of the nine subspecialties

were carefully recruited. Each academic area now has com-

mitted faculty members. There are currently 16 total faculty

members, with a complement of 18 as the goal. The program

submitted its program information form in December 2007

and received a site visit from the ACGME in July 2008.

The Diagnostic Radiology RRC met in November 2008 and

granted accreditation for a new LSU Radiology Residency

Program. Figure 2 shows a timeline of the program’s inter-

action with the ACGME.

The program has accepted three post-graduate year two

residents for July 2009 and has participated in the match for

the class beginning in July 2010. The Department of Radi-

ology will also enter the match for postgraduate year 1 resi-

dents entering in July 2010, if accreditation is granted. The

program has requested three resident positions for the inau-

gural class on the basis of the current number of procedures,

resources, and ACGME recommendations; initially, it plans

to accept three residents each year for the first couple of years.

However, the long-term goal is to admit approximately five

residents in the subsequent classes, faculty, finances, and

facilities permitting. The department’s objective is to have

a full complement of residents by 2012 to 2014. These ob-

jectives are all based on existing faculty, finances, and facil-

ities. The program is also excited about the prospect of a new

state-of-the-art hospital targeted for opening in 2014, in

physical proximity to a new Veterans Affairs medical center.

The LSU Department of Radiology practicing at LSU

Interim Hospital is now performing an annualized procedure

volume of >120,000, with a diverse array of case material;

this is approximately 60% of the case volume before Katrina

and is adequate to support a medium-sized residency pro-

gram. In addition, the department’s equipment level has been

restored. Table 4 shows the equipment currently available at

both University Hospital and New Orleans Children’s Hos-

pital. Pediatric training will take place at New Orleans Chil-

dren’s Hospital, a state-of-the-art facility that performs

>82,000 examinations annually. The department, in antici-

pation of its residency restarting, is also collaborating with

different clinical services, including neurology and vascular

surgery, on projects. For example, the radiology and the

vascular surgery departments now share a state-of-the-art

simulation lab in the School of Medicine’s Center for

Advanced Practice.

The department’s procedure volume at LSU Interim

Hospital has been consistently increasing and is projected to

level off at approximately 70% to 75% of pre-Katrina levels,

or roughly 150,000 to 160,000 procedures annually. This

projection mirrors the projection of the post-Katrina popu-

lation. Figure 3 shows MCLNO, University Hospital, and

LSU Interim Hospital monthly procedures performed in the

year prior to Katrina and each year since the storm.

Academic Radiology, Vol 16, No 5, May 2009 LSU RADIOLOGY: EFFECTS OF HURRICANE KATRINA

Figure 2. Timeline toward regaining Accreditation Council for Graduate Medical

Education (ACGME) accreditation. PIF, program information form; RRC, Diagnostic

Radiology Residency Review Committee.

A new state-of-the-art LSU hospital is slated to open in

2014. This is a $1.26 billion project that has been approved

by the Louisiana legislature as well as the previous and cur-

rent governors. This project has reached the design and de-

velopment phase. The 428-bed hospital will be immediately

adjacent to the LSUHSC campus and is designed to maintain

operations and to be self-sufficient for $10 days following

a hurricane of up to level 5 severity (‘‘hurricane hardened’’).

CONCLUSIONS

Should an institution suffer a major disruption such as

Hurricane Katrina, it is incumbent upon the institution at the

highest levels to work with departments to generate sufficient

order and resilience to assure residents and the ACGME that

resident education and patient safety are maintained. Loss of

Table 4Current Radiology Equipment Levels by Modality and Service atUniversity Hospital and New Orleans Children’s Hospital

Modality/Service University Hospital

New Orleans

Children’s Hospital

CT 2 1

MRI 1 1

Ultrasound 5 3

Mammography 3 0

Nuclear medicine 3 cameras (2 SPECT,

1 PET/CT)

2 cameras (both

SPECT)

RIS Fully integrated

RIS/PACS

Fully integrated

RIS/PACS

Radiography* 4 7

Radiographic

fluoroscopy

2 2

Angiography 2 (both single

plane)

1 (biplane)

CT, computed tomography; MRI, magnetic resonance imaging;PACS, Picture Archiving and Communication System; PET, positron

emission tomography; RIS, radiology information system;

SPECT, single photon-emission computed tomography.

* Radiographic units include chest units.

accreditation, even if voluntary, is likely to precipitate

faculty exodus and make the rebuilding effort even more

challenging.

The ACGME and the Centers for Medicare and Medicaid

Services have taken steps to address issues raised by disasters

such as Hurricane Katrina. For example, following Hurricane

Ike, it was determined that the University of Texas Medical

Branch in Galveston would not be able to provide all of its

residents and fellows with an acceptable educational expe-

rience in the near term. The ACGME facilitated the tempo-

rary transfer of the university’s residents and fellows by

asking accepting institutions to fill out an ‘‘available open-

ings for displaced residents’’ form, accessed through the

Accreditation Data System (2). One option available to the

ACGME is to allow a struggling program to downsize rather

than shut down following a disaster. Closing a training

program considerably slows down the recovery effort.

The Centers for Medicare and Medicaid Services has

recently modified its rules to now allow for the temporary

transfer of caps to institutions accepting residents if certain

criteria are met. This new change was brought about because

of the reluctance of hospitals to accept residents from closed

hospitals, because the accepting hospitals could not count the

additional residents for the purpose of Medicare graduate

medical education payments without temporary adjustments

to their caps (3).

Figure 3. Medical Center of Louisiana in New Orleans (MCLNO),

University Hospital, and Louisiana State University Interim Hospital

monthly procedures before Hurricane Katrina and each year afterthe storm. MCLNO was composed of two campuses, Charity

Hospital and University Hospital.

591

DUGGAL ET AL Academic Radiology, Vol 16, No 5, May 2009

Organizations such as the American College of Radiology

and the Association of University Radiologists can play an

important role in advancing the cause of training programs

affected by natural disasters. This can be accomplished by

disseminating the issues affecting the programs and by

influencing the accreditation and government policies in

a positive way.

The Office of Graduate Medical Education at the LSU

School of Medicine now has a revised disaster plan in place.

This plan is in compliance with both ACGME institutional

requirements and the LSUHSC requirements on weather-

related emergency procedures (4). The Department of Radi-

ology (as with all LSU School of Medicine departments) has

a list of all department personnel with their emergency

contact information available in multiple venues. A well-

developed disaster plan is not just about predisaster prepa-

ration but also about post-disaster reorganization. LSU’s

graduate medical education disaster plan includes specific

guidelines to deal with a prolonged absence of operations

from New Orleans. These guidelines include a directive that

program directors make contact with the ACGME, as well as

plan for relocation of graduate medical education office

administration, and regular meetings and communication.

The guidelines also outline procedures governing resident

reassignment, resident payroll, and resident transfers. In

short, efforts need to be made to re-establish orderly opera-

tions despite a disordered environment.

Although it may be difficult to foresee the specific damage

and disruption a natural disaster may bring to an institution, it

is important to have a plan to mitigate the impact of the

disaster and to ensure institutional resilience. It is essential for

each institution to plan to protect equipment and data; to

provide uninterrupted channels of communication among

administrators, faculty members, residents, and students; to

592

ensure continued resident education and patient safety; and to

ensure continued accreditation. Planning and preparation can

minimize the magnitude and length of disruptions and losses

from disasters. What we have also learned from the Depart-

ment of Radiology at LSU New Orleans is that, with resolve,

dedication, and thoughtful planning, recovery is possible

from even the most extreme devastation. Ironically, as we

worked on the final versions of this article, we tensely

awaited the arrival of Hurricane Gustav and all the uncer-

tainty that it brought the Louisiana coast, the School of

Medicine, and the Department of Radiology; the advance

planning and preparation for all levels of the institution

proved to be a wise and ‘‘good’’ investment of time and other

resources.

ACKNOWLEDGMENTS

We would like to thank Michael Hanemann, Dennis

Lindfors, MD, Carol Becker, MD, Cathi Fontenot, MD, and

Bettina Owens for the information they provided. We would

also like to thank the administrative and technical staff

members at LSU Interim Hospital, especially Robert Lea,

RT, and Art LaPorte, RT. Special thanks to Cathy Torres and

Sheila Johnson for their help and support.

REFERENCES

1. Winstead DK, Legeai C. Lessons learned from Katrina: One department’s

perspective. Acad Psychiatry 2007; 31:190–195.

2. Accreditation Council for Graduate Medical Education. Hurricane Ike

inquiries. Available at: http://www.acgme.org/acWebsite/newsRoom/

newsRm_IkeInq.asp. Accessed December 1, 2008.

3. US Department of Health and Human Services. Rules and regulations. Fed

Reg 2008; 73:4864.

4. Accreditation Council for Graduate Medical Education. ACGME institu-

tional requirements. Available at: http://www.acgme.org/acWebsite/irc/

irc_IRCpr07012007.pdf. Accessed August 26, 2008.